Abstract
Background/objectives
Identify clinical, sociodemographic, and nutritional predictors of hospital readmission within 30 days.
Subjects/methods
A longitudinal study was conducted with patients hospitalised at a public institution in Recife, Brazil. Sociodemographic (age, sex, race, and place of residence), clinical (diagnosis, comorbidities, medications, polypharmacy, hospital outcome, hospital stay, and occurrence of readmission within 30 days), and nutritional (% of weight loss, body mass index, arm circumference [AC], and calf circumference [CC]) characteristics were collected from the nutritional assessment files and patient charts. Nutritional risk was determined using the 2002 Nutritional Risk Screening tool and the diagnosis of malnutrition was based on the GLIM criteria.
Results
The sample was composed of 252 patients, 58 (23.0%; CI95%: 17.2–28.8%) of whom were readmitted within 30 days after discharge from hospital, 135 (53.5%; CI95%: 46.7–60.5%) were at nutritional risk and 107 (42.4%; CI95%: 35.6–49.3%) were malnourished. In the bivariate analysis, polypharmacy, nutritional risk, malnutrition, low AC, and low CC were associated with readmission. In the multivariate analysis, low CC was considered an independent risk factor, increasing the likelihood of hospital readmission nearly fourfold. In contrast, the absence of polypharmacy was a protective favour, reducing the likelihood of readmission by 81%.
Conclusions
The use of six medications or more and low calf circumference are risk factors for hospital readmission within 30 days after discharge.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Sharma Y, Miller M, Kaambwa B, Shahi R, Hakendorf P, Horwood C, et al. Factors influencing early and late readmissions in Australian hospitalised patients and investigating role of admission nutrition status as a predictor of hospital readmissions: a cohort study. BMJ Open. 2018;8:972–8. https://doi.org/10.1136/bmjopen-2018-022246
Zamir D, Zamir M, Reitblat T, Zeev W, Polishchuk I. Readmissions to hospital within 30 days of discharge from the internal medicine wards in southern Israel. Eur J Intern Med. 2006;17:20–23. https://doi.org/10.1016/j.ejim.2005.10.004
Sanson G, Bertocchi L, Dal Bo E, Di Pasquale CL, Zanetti M. Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults: A prospective longitudinal study. Int J Nurs Stud. 2018;82:40–48. https://doi.org/10.1016/j.ijnurstu.2018.03.007
Shen Y, Hao Q, Liu S, Su L, Sun X, Flaherty JH, et al. The impact of functional status on LOS and readmission in older patients in geriatrics department: a cohort study. Aging Clin Exp Res. 2020;32:1977–83. https://doi.org/10.1007/s40520-019-01411-3
Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, et al. Malnutrition at hospital admission—contributors and effect on length of stay: a prospective cohort study from the Canadian Malnutrition Task Force. J Parenter Enter Nutr. 2016;40:487–97. https://doi.org/10.1177/0148607114567902
Real GG, Frühauf IR, Sedrez JHK, Dall’Aqua EJF, Gonzalez MC. Calf circumference: a marker of muscle mass as a predictor of hospital readmission. J Parenter Enter Nutr. 2018;42:1272–9. https://doi.org/10.1002/jpen.1170
Waitzberg DL, Caiaffa WT, Correia MIT. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition. 2001;17:573–80. https://doi.org/10.1016/S0899-9007(01)00573-1
Correia MITD, Perman MI, Waitzberg DL. Hospital malnutrition in Latin America: a systematic review. Clin Nutr. 2017;36:958–67. https://doi.org/10.1016/j.clnu.2016.06.025
Bellanti F, Lo Buglio A, Quiete S, Pellegrino G, Dobrakowski M, Kasperczyk A, et al. Comparison of three nutritional screening tools with the new glim criteria for malnutrition and association with sarcopenia in hospitalized older patients. J Clin Med. 2020;9:1898 https://doi.org/10.3390/jcm9061898
Cederholm T, Jensen GL, MITD Correia, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition–a consensus report from the global clinical nutrition community. J Cachexia, Sarcopenia Muscle. 2019;10:207–17. https://doi.org/10.1002/jcsm.12383
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis. Report of the European Working Group on Sarcopenia in Older People A. J. Cruz-Gentoft et al. Age Ageing. 2010;39:412–23. https://doi.org/10.1093/ageing/afq034
Santos LP, Gonzalez MC, Orlandi SP, Bielemann RM, Barbosa‐Silva TG, Heymsfield SB. New prediction equations to estimate appendicular skeletal muscle mass using calf circumference: results from NHANES 1999–2006. J Parenter Enter Nutr. 2019;43:998–1007. https://doi.org/10.1002/jpen.1605. COCONUT Study Group
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31. https://doi.org/10.1093/ageing/afy169
Blackburn GL, Thornton PA. Nutritional assessment of the hospitalized patient. Med Clin North Am. 1979;63:11103–15.
Chumlea WC, Roche AF, Steinbaugh ML. Estimating stature from knee height for persons 60 to 90 years of age. J Am Geriatrics Soc. 1985;33:116–20.
Chumlea WC, Guo SS, Steinbaungh ML. Prediction of stature from knee height for black and white adults and children with application to mobility impaired or handicapped persons. J Am Diet Assoc. 1994;94:1385–8.
Lipschitz DA. Screening for nutritional status in the elderly. Prim Care. 1994;1:55–67.
World Heath Organization. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation on Obesity. Geneva: World Heath Organization; 1998.
Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign: Human Kinetics Books. 1988. vol. 177, pp. 3–8.
Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. 1981;34:2540–5.
Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status. University of Michigan Press; 1990.
Burr ML, Phillips KM. Anthropometric norms in the elderly. Br J Nutr. 1984;51:165–9.
Blackburn GL, Thornton PA. Nutritional assessment of the hospitalized patient. Med Clin North Am. 1979;63:11103–15.
Barbosa‐Silva TG, Bielemann RM, Gonzalez MC, Menezes AMB. Prevalence of sarcopenia among community‐dwelling elderly of a medium‐sized South American city results of the COMO VAI? study. J Cachexia, Sarcopenia Muscle. 2016;2:136–43. https://doi.org/10.1002/jcsm.12049
Ukleja A, Gilbert K, Mogensen KM, Walker R, Ward CT, Ybarra J, et al. Standards for nutrition support: adult hospitalized patients. Nutr Clin Pract. 2018;33:906–20. https://doi.org/10.1002/ncp.10204
Gadre SK, Shah M, Mireles-Cabodevila E, Patel B, Duggal A. Epidemiology and predictors of 30-day readmission in patients with sepsis. Chest. 2019;155:483–90. https://doi.org/10.1016/j.chest.2018.12.008
Siegel S, Fan L, Goldman A, Higgins J, Goates S, Partridge J. Impact of a nutrition-focused quality improvement intervention on hospital length of stay. J Nurs care Qual. 2019;34:203–9. https://doi.org/10.1097/NCQ.0000000000000382
Wilbur MB, Mannschreck DB, Angarita AM, Matsuno RK, Tanner EJ, Stone RL, et al. Unplanned 30-day hospital readmission as a quality measure in gynecologic oncology. Gynecologic Oncol. 2016;143:604–10. https://doi.org/10.1016/j.ygyno.2016.09.020
Lima FV, Kolte D, Rofeberg V, Molino J, Zhang Z, Elmariah S, et al. Thirty‐day readmissions after transcatheter versus surgical mitral valve repair in high‐risk patients with mitral regurgitation: Analysis of the 2014–2015 Nationwide readmissions databases. Catheterization Cardiovascular Interventions. 2020;96:664–74. https://doi.org/10.1002/ccd.28647
Guzman AK, Zhang M, Kwatra SG, Kaffenberger BH. Predictors of 30-day readmission in Stevens-Johnson syndrome and toxic epidermal necrolysis: A cross-sectional database study. J Am Acad Dermatol. 2020;82:303–10. https://doi.org/10.1016/j.jaad.2019.09.017
Deutz NE, Matheson EM, Matarese LE, Luo M, Baggs GE, Nelson JL, et al. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr. 2016;35:18–26. https://doi.org/10.1016/j.clnu.2015.12.010
Sriram K, Sulo S, VanDerBosch G, Partridge J, Feldstein J, Hegazi RA, et al. A comprehensive nutrition‐focused quality improvement program reduces 30‐day readmissions and length of stay in hospitalized patients. J Parenter Enter Nutr. 2017;41:384–91. https://doi.org/10.1177/0148607116681468
Lim SL, Ong KCB, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31:345–50. https://doi.org/10.1016/j.clnu.2011.11.001
Micic D, Gaetano JN, Rubin JN, Cohen RD, Sakuraba A, Rubin DT, et al. Factors associated with readmission to the hospital within 30 days in patients with inflammatory bowel disease. PLoS ONE. 2017;12:e0182900 https://doi.org/10.1371/journal.pone.0182900
Fiorindi C, Luceri C, Dragoni G, Piemonte G, Scaringi S, Staderini F, et al. GLIM Criteria for Malnutrition in Surgical IBD Patients: A Pilot Study. Nutrients. 2020;12:2222 https://doi.org/10.3390/nu12082222
Martín CAG, Vázquez VAA, Hernández FB, Medina CRA, Carrillo SLA, Flores AC, et al. The GLIM criteria for adult malnutrition and its relation with adverse outcomes, a prospective observational study. Clin Nutr ESPEN. 2020;38:67–73. https://doi.org/10.1016/j.clnesp.2020.06.015
Fischer M, JeVenn A, Hipskind P. Evaluation of muscle and fat loss as diagnostic criteria for malnutrition. Nutr Clin Pract. 2015;30:239–48. https://doi.org/10.1177/0884533615573053
Leandro-Merhi VA, De Aquino JLB, Reis LO. Predictors of nutritional risk according to NRS-2002 and calf circumference in hospitalized older adults with neoplasms. Nutr Cancer. 2017;69:1219–26. https://doi.org/10.1177/0884533615573053
Tarnowski M, Stein E, Marcadenti A, Fink J, Rabito E, Silva FM. Calf circumference is a good predictor of longer hospital stay and nutritional risk in emergency patients: a prospective cohort study. J Am Coll Nutr. 2020;1:5 https://doi.org/10.1080/07315724.2020.1723452
Gelder J, Lucke JA, de Groot B, Fogteloo AJ, Anten S, Heringhaus C, et al. Predictors and outcomes of revisits in older adults discharged from the emergency department. J Am Geriatrics Soc. 2018;66:735–41. https://doi.org/10.1111/jgs.15301
Turnbull AJ, Donaghy E, Salisbury L, Ramsay P, Rattray J, Walsh T, et al. Polypharmacy and emergency hospital readmission after critical illness: a population-level cohort study. Br J Anaesth. 2020. https://doi.org/10.1016/j.bja.2020.09.035
Sehgal V, Bajwa SJS, Sehgal R, Bajaj A, Khaira U, Kresse V. Polypharmacy and potentially inappropriate medication use as the precipitating factor in readmissions to the hospital. J Fam Med Prim Care. 2013;2:94 https://doi.org/10.4103/2249-4863.117423
Hellemans L, Hias J, Walgraeve K, Flamaing J, Spriet I, Tournoy, et al. Deprescribing in geriatric inpatients is associated with a lower readmission risk: a case control study. Int J Clin Pharm. 2020;42:1374–8. https://doi.org/10.1007/s11096-020-01091-4
Acknowledgements
We would like to express our gratitude to all patients who were under our care during the development of this line of research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Cruz, P.L.M., Soares, B.L.d.M., da Silva, J.E. et al. Clinical and nutritional predictors of hospital readmission within 30 days. Eur J Clin Nutr 76, 244–250 (2022). https://doi.org/10.1038/s41430-021-00937-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41430-021-00937-y
This article is cited by
-
Time to readmission and associated factors after post treatment discharge of severe acute malnourished under-five children in Pawe General Hospital
Journal of Health, Population and Nutrition (2022)
-
Nationwide hospital admission data statistics and disease-specific 30-day readmission prediction
Health Information Science and Systems (2022)